05 FECYT 2076 SCIENTIFIC ARTICLE

EFFECT OF BIOFEEDBACK PSYCHOPROPHYLACTIC PROTOCOL
PRE AND POSTSURGICAL
Psc. Juan Francisco Cadena Salazar – Psc. Cl. Jorge Gordón Rogel
General Psychology
[email protected] ; [email protected]
Abstract: Psychological research walked with the idea of trying to objectively outline the contents
of the human mind that are hardly observable, where subjectivity expressed in emotions, thoughts
and behaviors are revealed in every response that the body runs. Patients in the Hospital of the
Ecuadorian Institute of Social Security Ibarra demonstrating that subjectivity as stress, when facing
a surgical procedure outlined their emotional reactions mainly anxiety and sadness. Psychological
intervention sailed from collecting information of emotional expressions, using psychometric
techniques; and reaction of the autonomous nervous system in the presence of pre- and
postoperative stress using psychophysiological assessment techniques. The reduction of such
events was performed by means of psychotherapeutic effect of biofeedback (biofeedback), since
the benefit provided to the patient as a technique Accompanying prior to entering the operating
room time and in the immediate convalescence was evident after surgery. From the results obtained
psychoprophylactic intervention protocol appears, confirming that the application resource
biofeedback intervention favorably complements professional psychologist to reduce stress and its
manifestations in patients around the surgical process.
Key words: Biofeedback; surgical psychoprophylaxis; surgical stress; psychophysiology;
psychotherapeutics techniques; psychophysiological and psychometric assessment
techniques; heart rate variability.
Resumen: La investigación psicológica se encaminó con la idea de intentar esbozar
objetivamente los contenidos de la mente humana que son observables difícilmente, donde
la subjetividad expresada en emociones, pensamientos y conductas se revela en cada
respuesta que el cuerpo ejecuta. Los pacientes del Hospital del Instituto Ecuatoriano de
Seguridad Social de Ibarra manifestaban dicha subjetividad como estrés, en el momento de
enfrentarse a un proceso quirúrgico, sus reacciones afectivas principalmente esbozaron
ansiedad y tristeza. La intervención psicológica zarpó desde la recolección de información
de las expresiones emocionales, usando técnicas psicométricas; y la reacción del sistema
nervioso autónomo en presencia de estrés pre y postoperatorio, empleando técnicas de
evaluación psicofisiológica. La reducción de dichas manifestaciones se realizó por medio
del efecto psicoterapéutico de biorretroalimentación (biofeedback), dado que se evidenció el
beneficio que brinda al paciente como técnica de acompañamiento en el momento previo al
ingreso a la sala de operaciones y en la convalecencia inmediata después de una cirugía. De
los resultados obtenidos se desprende un protocolo de intervención psicoprofiláctica,
confirmando que la aplicación del recurso de biorretroalimentación complementa
favorablemente la intervención del profesional en psicología en la reducción del estrés y sus
manifestaciones en los pacientes alrededor del proceso quirúrgico.
Palabras claves: Biorretroalimentación; psicoprofilaxis quirúrgica; estrés quirúrgico;
psicofisiología; técnicas psicoterapéuticas; técnicas de evaluación psicofisiológica y
psicométrica; variabilidad de la frecuencia cardiaca.
Introduction
Patients attending health houses second-level conditions that require surgical intervention,
crossing all this hospital process with the presence of stress, expressed in psychological
manifestations, masked in fear and / or sadness. Those psychological manifestations since
ancient times occurred relate to the idiosyncrasies of individual death, because surgery is a
potent stressor complex; and stressful nature is not unique, depends not only hospitalization
but the disease, events and their consequences, even of biopsychological constitution of
each individual and successfully address this process reduces time after surgery
convalescence.
In the interpretation of the definition of biofeedback (biofeedback), several authors agree
that is the psychophysiological method to record vital frequencies body of an individual,
reflecting the information on the activity of biological process. This same information is
useful to modify aspects involuntary consciously; that, through the use of sensitive
instrumentation provides accurate and immediate information regarding muscle activity,
brain waves, body temperature, heart rate, blood pressure and other bodily functions
susceptible to measurement, quantification and feedback. It is precisely the knowledge of
results allowing learning to control a given behavior. In the case of such conduct is
physiological biofeedback, behavior which, under normal conditions, is not conscious, but
by technological support may perceive different.
To Mucci (2004) surgical psicoprofilaxis is one psychotherapeutic process with preventive
objectives focused on the surgical situation, planning the affective, cognitive, behavioral
and interactional patient's functional promotion. Use resources to meet surgery, reduce
adverse effects and facilitate the biopsychosocial recovery. Within the general objectives of
surgical psicoprofilaxis find that facilitates the processing of information, provides
resources to meet the mindset that surgery and that the disease imposes on the patient,
stabilize the psychological symptoms to tolerable levels, reduce basic fears, prevent surgical
experience implements a psychopathology.
Better preparation of the patient psychological component is to provide information,
counseling throughout the surgical process and the following sensations intervention, fits
the person, reducing stressful characteristics and emotional reactions, variability
biofeedback was used heart rate (HRV), as an exercise in psychological approach to
stressful situations such as surgery and use of this lawsuit instituted as a preventative tool
and adjunct to proper recovery of the individual resource.
The emotional manifestations found in psychometric and psychophysiological signed
anxiety and depression, according Corr (2008), where defensive behaviors when it enters a
appetitive environment, anxiety experienced when the threat is preventable and depression
is observed when the threat is inevitably, therefore proposes a scheme with respect to
defensive systems that can route to the pathology of emotional reactions and affections
against danger, to solve this scheme timely psychological intervention was performed.
Psychoprophylactic surgical intervention in three indicators that demonstrated the beneficial
effect of biofeedback of heart rate variability (HRV) of patients before and after surgery,
which were matched with data from psychometric scales were found.
PRESURGERY
Anxiety-Depression Scale Goldberg
STADISTIC TABLE
GRAPHIC REPRESENTATION
Diagnostic classification
ƒ
%
Anxiety
2
6,67
Depression
3
10,00
Anxiety/Depression
19
63,33
Euthymia
6
20,00
30
100
SOURSE: ANXIETY-DEPRESSION SCALE GOLDBERG PRESURGERY
AUTHOR: JUAN F. CADENA
Biofeedback Registry
1. Spectral Analysis of Heart Rate Variability (HRV) presurgery
STADISTIC TABLE
Heart Frecuency
GRAPHIC REPRESENTATION
Pre - training
Training
Post - training
ƒ
%
ƒ
%
ƒ
%
Very Low Frecuency (VLF)
27
90,00
0
0
0
0
Low Frecuency (LF)
0
0
30
100
30
100
3
10,00
0
0
0
0
30
100
30
100
30
100
High Frecuency (HF)
SOURCE: BIOFEEDBACK REGISTRY
AUTHOR: JUAN F. CADENA
2. Wave interpretetion registry presurgery
STADISTIC TABLE
Wave classification
Pre - training
GRAPHIC REPRESENTATION
Training
Post - training
f
%
f
%
f
%
Sinusoid
3
10,00
26
86,67
25
83,33
Sinusoid/Anxious
1
3,33
3
10,00
3
10,00
Sinusoid/Depressive
1
3,33
0
0,00
0
0,00
Ansxious
9
30,00
1
3,33
1
3,33
Depressive
5
16,67
0
0,00
1
3,33
Anxious/Depressive
11
36,67
0
0,00
0
0,00
30
100
30
100
30
100
SOURCE: BIOFEEDBACK REGISTRY
AUTHOR: JUAN F. CADENA
3. Biofeedback coherence score presurgery
STADISTIC TABLE
Biofeedback Coherence
Pre - training
( )
(Ѕ)
GRAPHIC REPRESENTATION
Post - training
Training
( )
(Ѕ)
( )
(Ѕ)
HIGH
16%
13%
81%
15%
72%
24%
MIDLE
17%
6%
11%
10%
14%
11%
LOW
67%
17%
8%
8%
14%
15%
SOURCE: BIOFEEDBACK REGISTRY
AUTHOR: JUAN F. CADENA
Correlation of presurgery instruments at the pre-training phase
STADISTIC TABLE
Goldberg
Scale
Wave Biofeedback
Registy
ƒ
%
ƒ
%
2
6,67
10
33,33
Depressive
3
10,00
6
20,00
Anxiety / Depression
19
63,33
11
36,67
Euthymia
6
20,00
3
10,00
Total
30
100
30
100
Diagnostic Classification
Anxiety
STADISTIC TABLE
PRESURGERY CORRELATION
Goldberg Scale
Wave Registry
Goldberg Scale
Pearson Correlation
Sig. (bilateral)
1
0,794
0,000
Wave Registry
Pearson Correlation
0,794
1
Sig. (bilateral)
0,000
SOURCE: SOFTWARE SPSS
AUTHOR: JUAN F. CADENA
GRAPHIC REPRESENTATION
FUENTE: SOFTWARE SPSS
AUTOR: JUAN F. CADENA
POSTSURGERY
Zung Anxiety Scale
STADISTIC TABLE
GRAPHIC REPRESENTATION
Diagnostic classifitaction
ƒ
%
Normal Range
29
96,67
Slightly anxious
0
0,00
Moderately anxious
1
3,33
0
0,00
30
100
Severely anxious
SOURCE: ZUNG ANXIETY SCALE
AUTHOR: JUAN F. CADENA
Zung – Condes Depression Scale
STADISTIC TABLE
GRAPHIC REPRESENTATION
Diagnostic classifitaction
f
%
Normal Range
29
96,67
Slightly depressed
1
3,33
Moderately depressed
0
0,00
0
0,00
30
100
Severely depressed
SOURCE: ZUNG – CONDES DEPRESSION SCALE
AUTHOR: JUAN F. CADENA
Biofeedback Registry
1. Spectral Analysis of Heart Rate Variability (HRV) postsurgery
STADISTIC TABLE
Heart Frecuency
Pre - training
GRAPHIC REPRESENTATION
Training
Post - training
ƒ
%
ƒ
%
ƒ
%
20
66,67
2
6,67
3
10,00
Low Frecuency (LF)
3
10,00
28
93,33
27
90,00
High Frecuency (HF)
7
23,33
0
0
0
0
30
100
30
100
30
100
Very Low Frecuency
(VLF)
SOURCE: ZUNG – CONDES DEPRESSION SCALE
AUTHOR: JUAN F. CADENA
2. Wave interpretetion registry postsurgery
STADISTIC TABLE
Wave classification
GRAPHIC REPRESENTATION
Pre - training
Training
Post - training
ƒ
%
ƒ
%
ƒ
%
Sinusoid
3
10,00
24
80,00
23
76,67
Sinusoid/Anxious
1
3,33
5
16,67
3
10,00
Sinusoid/Depressive
0
0,00
0
0,00
0
0,00
Anxious
19
63,33
1
3,33
3
10,00
Depressive
0
0,00
0
0,00
0
0,00
Anxious/Depressive
7
23,33
0
0,00
1
3,33
30
100
30
10
30
100
SOURCE: BIOFEEDBACK REGISTRY
AUTHOR: JUAN F. CADENA
3. Biofeedback coherence score postsurgery
STADISTIC TABLE
Biofeedback Coherence
GRAPHIC REPRESENTATION
Pre - training
Post - training
Training
( )
(Ѕ)
( )
(Ѕ)
( )
(Ѕ)
HIGH
10%
10%
73%
29%
65%
31%
MIDLE
14%
8%
12%
11%
14%
10%
LOW
75%
16%
15%
15%
20%
26%
SOURCE: BIOFEEDBACK REGISTRY
AUTHOR: JUAN F. CADENA
Correlation of postsurgery instruments at the pre-training phase
CUADRO ESTADÍSTICO
Psychological Test
Wave Biofeedback Registry
Diagnostic classification
ƒ
%
ƒ
%
Anxiety
1
3,33
20
66,63
Depressive
1
3,33
0
20,00
Anxiety / Depressive
0
0
7
23,33
Euthymia
28
93,34
3
10,00
Total
30
100
30
100
CUADRO ESTADÍSTICO
POSTSURGERY CORRELATION
Psychological Test
Wave registy
FUENTE: SOFTWARE SPSS
AUTOR: JUAN F. CADENA
Psychological Test
Wave registy
Pearson Correlation
1
-0,810
Sig. (bilateral)
Pearson Correlation
Sig. (bilateral)
-0,810
0,000
0,000
1
GRAPHIC REPRESENTATION
FUENTE: SOFTWARE SPSS
AUTOR: JUAN F. CADENA
It should be noted that the mirrored data are arranged from the tabulation of information, a high
level of sensitivity is handled in them; to this every psychological reagent handling your
confidence, registration wave at the interface of biofeedback was established by the qualitative
interpretation of the researcher, associated with symptomatology observed in subjects and
provisions that the developer of the software places as a guide data interpretation.
Methodology: Psychological intervention was divided into two moments: PRESURGERY y
POSTSURGERY. In each of the three phases of application times of the clinical and
psychometric split method, which were named: Pre-training, Training y Post-training.
The first phase of PRE-TRAINING at presurgery moment, a brief psychological structured
interview, where personal history of the patient was recorded through a Psychological
Clinic Brief History was made. Higher mental functions were evaluated Anxiety ScaleDepression Goldberg was applied and combined with the registration of the HRV
biofeedback software company emWave® Pro Heartmath®. Postoperatively time the Zung
Anxiety Scale was applied and the Zung Depression Scale and Counts, combined with a
technique called psychological debriefing and recording of HRV biofeedback software.
Pre-entrenamiento phase is performed in a period of ten minutes in both moments.
Second phase or TRAINING at pre and postsurgery moment, the interface exercise
technique biofeedback, where the patient is induced suggestions, runs behavioral and
cognitive enhancers to induce the patient to perform the technique in order to remove
surgical stress and psychological manifestations is used, this phase has an approximate time
of ten minutes each time.
Thir phase denominated POST-TRAINING in both moments, training technique
biofeedback for which he used an exercise within the software, the interface is extended to
ten minutes, was obtained as an indicator of learning the technique when culminating
exercise ahead of time, applies to this cognitive enhancers were used and behavioral
maximize the performance of patients.
Upon completion of each phase is continued where performance of the patient at the time of
each assessment, recording and performing biofeedback technique is explained.
Psychological manifestations found were also reported and the patient for the
implementation of the technique is prepared each lag is within five minutes.
Data were collected from observation forms, psychometric scales and the information
obtained from these to be organized in tables and statistical graphs for better understanding
tabulated.
Evaluation of Results: The effect of biofeedback technique in the affective manifestations
of patients undergoing surgical stress is set to benefit in reducing psychological reactions,
for which it was established as psychoprophylactic intervention protocol has its impacts in
the following areas:
Social Domain: The use of psychophysiological instruments in the evaluation of mood and
training regulating emotional manifestations permeates every individual cognition of the
actions of a professional in psychology which combines the biological field, technology and
psychology, decreasing the subjective experience of emotional response, providing
resources for coping with surgical stress.
Scientific Domain: Relate psychological and psychophysiological evaluation process
clinician provides a widely worthwhile goal to intrude into the exclusive subtle instances of
individual subjectivity as the mood and the myriad of thoughts that each individual faces as
surgical stress. He also brings with theoretical and practical bases in development of
psychotherapeutic techniques that prevent empowerment of psychopathological clinical
pictures.
Professional Domain: It leaves open the door to the use of technological tools such
evaluative and therapeutic resource, as an adjunct to a closer reality of individual diagnosis
and establishes as a tool for direct application in situ.
Related investigations: Research on the application of biofeedback in pre- and postsurgical
patients do not exist in local repositories.
However, research is motivated by psychological intervention carried out in 2011 in the same
health institution by Andrade, S. traditionally framed the application of psychological techniques
to reduce patient anxiety. He also made reference to the "Review of biofeedback techniques and
their applications," Research by Conde Balaña Pasto & Menéndez (2002) that led to the
acquisition of knowledge in the various forms of biofeedback applied in different contexts.
Conclusions
1. Psychological manifestations presented by patients in the preoperative and
postoperative moments were anxiety and depression, found through
psychophysiological records, clinical observation and psychological scores reagents.
The appreciation is associated with the philosophical school hermeneutics with its
objective to interpret how best coping surgery by the subjects investigated.
2. The indicators of the effect of biofeedback technique that settled in the investigation
was three. The first spectral analysis of HRV forming frequencies; the second type of
wave recorded in the psychophysiological software; finally reached the level of
consistency in the performance of biofeedback training.
3. The biofeedback technique is established as an effective technique to evaluate, diagnose
and treat psychological manifestations in patients undergoing stress.
4. The intervention protocol has been established as a practical psychotherapeutic
resource. The steps have been followed constitute a planned and documented
application with the intention of helping individuals overcome successful surgery,
which has been reflected in patient satisfaction.
Recommend
1. One way to provide a resource for coping successfully refunded homeostatic state of
health of patients in public hospitals by the Ecuadorian state is integrated into their
surgical psychoprophylaxis.
2. Bring a descriptive statistical frequency as stressful to patients before and after surgery
now provide information attached to the psychological reality of users of the Hospital of
the Ecuadorian Institute of Social Security Ibarra.
3. The authorities of the Ecuadorian Social Security Hospital Ibarra, is recommended to
promote the evaluation of the psychological status of each patient to undergo surgery.
4. Coordinate a multidisciplinary between professionals in psychology, medicine and
nursing, will allow the surgical process is performing in an effective manner at all times
of intervention.
References
1. Andrade, S. A. (2011). Asistencia Psicológica a pacientes en situación preoperatoria, del
hospital del IESS de la ciudad de Ibarra, en el segundo semestre del año 2010. (Tesis de
Grado previa a la obtención del título de psicólogo clínico). Universidad Cristiana
Latinoamericana. Ibarra.
2. Barrilero Gómez, J., & otros. (1998). Ansiedad y cirugía. Repercusiones en el paciente
sometido a cirugía programada. Revista de enfermería(08).
3. Caballo, V. (1998). Manual de técnicas de terapia y modificación de conducta. Madrid:
Siglo XXI de España Editores S.A.
4. Conde Pasto, M., & Menéndez Balaña, F. J. (2002). Revisón de las técnicas de
Biofeedback y sus aplicaciones. Acción Psicológica 2, 165-181.
5. Consuegra Anaya, N. (2010). Diccionario de Psicología (Segunda ed.). Bogotá: Eoe
Ediciones.
6. Corr, P. (2008). Psicología biológica. (S. Olivares, & G. Padilla, Trads.) México D.F.:
McGraw-Hill/Interamericana Editores S.A. de C.V.
7. Chóliz Montañés, M., & Capafóns Bonet, A. (1990). Revisión conceptual del biofeedback.
Análisis y Modificación de Conducta, 16, 49.
8. Marín Agudelo, H. A., & Vinaccia Alpi, S. (2005). Biofeedback: de las técnicas de
modificación de conducta, aplicada a los problemas mentales, a las ténicas de intervención
de los problemas físicos. Informes psicológicos, 109-121.
9. Mucci, M. (2004). Psicoprofilaxis quirúrgica: Una práctica en convergencia
interdisciplinaria. Buenos Aires: Paidós SAICF.
10. Navas, M. (2008). Nivel de ansiedad del paciente quirúrgico en el preoperatorio y
postoperatorio inmediato y factores de riesgo. Cuidando la salud, Revista científica de
enfermería, 36-51.
11. Schwartz, M. S., & Andrasik, F. (2003). Biofeedback: A Practitioner’s Guide. New York:
Guilford Press.
12. West, K. (2007). Biofeedback. New York: Infobase Publishing.

Download Report